NPI | 1205873270 |
---|---|
Entity Type | Organization |
Authorized Contact | BRIAN D EBERHART President 574-258-4344 |
Organization Subpart ? | No |
Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: IN 8569) |
Enumeration Date | 2006-05-31 |
Last Update Date | 2020-08-22 |